RS Signs Flashcards
Pulse
Paradoxical- respiratory distress
Bounding- CO2 rention.
Face
Ptosis and constricted pupil- horners eg pancoast tumour.
Blue tongue and lips- central cyanosis.
Pale conjunctiva- anaemia.
Tracheal displacement
Towards collapse or UNILATERAL fibrosis or lung removal.
Away from large pleural effusion or tension pneumothorax.
Slight R deviation normal.
Cricosternal distance over 3cm- hyperexpansion.
Tracheal tug on inspiration- severe airflow restriction.
Lymphadenopathy
CA
TB
Raised JVP
Cor pulmonale
Apex beat
Impalpable- COPD, pleural effusion, dextrocardia.
Expansion
Under 5cm on deep inspiration abnormal. Should be symmetrical. -unilaterally low- Pneumonia, pneumothorax, pleural effusion, lobar collapse. -bilateral- ILD stiffness, hyperinflation.
Percussion
Dull- collapse, consolidation, fibrosis, pleural thickening, pleural effusion STONY DULL.
Hyperresonant- pneumothorax or hyperinflation (COPD).
Breath sounds
- Normal vesicular rustling
- Brochial breathing- harsh with gap between inspiration and expiration. Occurs in firm lung tissue eg consolidation (pneumonia), fibrosis, above a pleural effusion, large pericardial effusion. May have increased vocal resonance too.
- Diminished breath sounds- pleural effusion, pleural thickening, oneumothorax, bronchial obstruction, asthma, COPD.
- Silent- life threatening asthma.
- Wheeze- monophonic if partial obstruction of one airway eg tumour.
Polyphonic if widespread narrowing of differing calibre eg asthma, COPD. Also LVF cardiac asthma.
-Crackles/crepitations- caused by re opening during inspiration of small airways occluded during expiration.
Fine and late in inspiration if coming from distal air spaces eg pulmonary oedema, fibrosing alveolitis.
Coarse in mid inspiration if proximal eg bronchiectasis.
In early inspiration if small airways disease eg COPD.
Late or pan inspiration if alveolar disease.
-stridor- part obstruction upper airways. Lumen, wall or extrinsic. - Pleural rubs- inflammatory exudate roughens pleural surfaces eg pneumonia, pulmonary infarction.
- loud clear vocal resonance if consolidation (brochial breathing).
Decreased vocal resonance if pneumothorax, pleural effusion.
Normal is muffled.
Hyperventilation- fast or deep.
Can lead to respiratory alkalosis and hence parasthesia.
Main cause in anxiety.
- kussmaul deep sighing in metabolic acidosis eg DM or alphoholic ketoacidosis, renal impairment.
- neurogenic- pontine lesions.
- hyperventilation syndrome panic attacks
Cheyne stokes deeper then shallower in cycles
brainstem lesions or compression eg RICP, stroke.
Sputum
- black carbon specks- smoking.
- yellow or green- infection eg bronchiectasis, pneumonia.
- pink frothy- pulmonary oedema.
- haemoptysis- malignancy, TB, infection, trauma.
Deformities
- barrell chest AP diameter, reduced expansion, tracheal descent- chronic hyperinflation eg COPD, asthma.
- pectus carinatum sternal prominence - lung hyperinflation while thorax still developing eg chronic childhood asthma.
- pectus exacavatum lower sternal depression- developmental defect. Associated with scoliosis, marfans and ehlers. Can cause heart displacement and reduced capacity.
- kyphosis increased AP T spine curvature.
- scoliosis- lateral curvature.
Stridor inspiration
Partial obstruction upper airways.
In lumen eg FB, tumour, VC palsy.
In wall eg oedema, laryngospasm, tumour, croup, epiglittitis, amyloidosis.
Extrinsic eg goitre, oesophagus, lymphadenopathy, post op.
Cough
- loud brassy- pressure on trachea eg tumour.
- hollow bovine- RLN palsy.
- barking- croup.
- chronic- pertissis, TB, FB, asthma.
- dry chronic- oesophageal reflux, ACEi.
- painful
- throat clearing
Under 3 weeks- RTI
Over 3 weeks- COPD, asthma, CA, meds eg ACEi
Haemoptysis
Frothy, alkaline, bright red
- infective- TB, brochiectasis, pneumonia, abcess, COPD, fungus, virus (pneumonitis, hep, HIV), helminth, bronchitis.
-pulmonary oedema-frothy pink. - neoplastic- primary or secondary
- vascular- PE, vasculitis, HHT, AVM, capillaritis.
- parenchymal- fibrosis, sarcoidosis, haemosiderosis, CF.
- pulmonary HTN- idiopathic, TE, cyanotic CHD, fibrosis, bronchiesctasis.
- caogulopathy- thrombocytopenia, warfarin.
- trauma or FB- post intubation, eroding defib.
Find out how much
Differentiate from haematemesis.
Dyspnoea-
Awareness that abnormal effort to breathe
- lung
- cardiac- IHD, LVF, MV stenosis.
- anatomical- chest wall, muscle or pleura disease. Ascites.
- other- shock, anaemia, respiratory acidosis.
ACUTE- FB, pneumothorax, PE, acute pulmonary oedema.
SUBACUTE- asthma, parenchymal disease eg alveolitis pneumonia.
CHRONIC- COPD, HF, anaemia.
Signs- accessory muscle, tracheal tug, nasal flaring, sternal retraction, intercostal recession, tripoding.
-Qs- onset duration, how long for, how much exercise, previous heart/lung issues, fever, smoke, pain.
-differentials- unfit, infection, efffusion, COPD, asthma.
General inspection
COINS Chest drain O Inhalers News Sputum pot Breathing, accessory muscles, colour etc.
Horners
T1 lesion due to pancoast tumour (brochial carcinoma) in lung apex compressing sympathetic chain. Intrinsic muscle wasting Ptosis Anhydrosis Mitosis
Pleural effusion signs
Reduced expansion Stony dull percussion Reduced air entry Reduced vocal resonance Veiscaular breath sounds, reduced intensity on affected side. Tracheal deviation away if large
Consolidation signs
Consolidation- fluid inside alveoli
Effusion- fluid in pleural space
Reduced expansion
Dull percussion
Increased vocal resonance
Bronchial breathing, possible coarse crackles.
Collapse signs
Due ot large airway obstruction eg CA
Reduced expansion on affected side Dull or normal percussion Reduced breath sounds on affected side Trachea deviation towards Reduced vocal resonance
Pneumothorax signs
Reduced expansion
Hyperresonance
Reduced breath sounds, cab be absent in tension
Trachea deviated away from tension pneumothorax
Reduced vocal resonance
Fibrosis signs
Reduced expansion on affected side(s) Dull or normal percussion Fine inspiratory crackles Trachea pulled towards unless bilateral fibrosis. Vesicular breath sounds Normal or increaed vocal resonance FEV1/FVC normal but FVC very low Low diffusion capacity
Cause of exudative effusion
Inflammation
Infection
??
Causes of transudative effusion
HF
??
Virchows triad
Vessel wall
Blood components
Blood flow
HF vs DVT
DVT unilateral
HF- pitting oedema and bilateral and worse through day.
DVT- pain, red, hot, tender
Horners syndrome
Triad- miosis (pupil constriction), partial ptosis, ipsilateral anhidrosis (lack sweat).
Interrupted face SNS supply eg at throacic outlet (pancoast tumour). Or brainstem, SC, ICA hitchhike.
Pancoast syndrome
Apical lung CA invades SNS plexus in neck.
Can= ipsilateral horners, brachial plexus lesion, RLN lesion.
Sarcoidosis
Multisystem non caseating granulomtous disorder. Unknown cause. Afro carribean and asian.
Usually asymptomatic, can get cough or rash. Acute= erythema nodosum.
Lungs- pulmonary lymphadenopathy and infiltration/fibrosis.
Other- lymphadenopathy, hepatomegaly, splenomagaly, conjunctivitis, glaucoma, bone cyst, bell splasy, meningitis, SOL, renal stones, pituitary dysfunction.
Tx- rest and NSAIDs. Occasionally steroids or methotrexate.
Differentials- lymphoma, TB.
Stridor
Luminal- FB, tumour, VC palsy
In wall- anaphylaxis oedema, laryngospasm, tumour, croup, epgilottitis, amyloidosis.
Extrinsic- goitre, oesophagus, LN, post op.
Type 2 respiratory depression causes
- respiratory depression- head injury, drugs.
- muscle weakness- SC injury, peripheral neuropathy, NMJ, myopathy.
- chest wall problems- obesity.
- lungs difficult to ventilate- late acute asthma, COPD, fibrosis.
Type 1 respiratory failure causes
V/Q mismatch (hyperventilation cannot increase O content)
- early acute asthma- V/Q mismatch.
- PE- V/Q mismatch.
- fibrosing alveolitis- increase diffusion distance. Affects O more as lower solubility.
Central cyanosis oral mucosa or tongue
Arterial sats under 90%
PO2 8kPa
Hyperinflation
More than 6 anterior ribs seen.
Flat hemidiaphragms.
Ribs more horizontal.
Normally in full inspiration diaphragm crosses 6th rib anteriorly.
T1 respiratory failure- low arterial O, normal/low CO2 as hypoxia stimulated RR
Mechanism-
Poor diffusion across alveoli-
-fibrosis increase distance
-emphysema decrease sa
V/Q mismatch
-reduced ventilation to part of lung (V/Q under 1)- pneumonia, acute severe asthma, RDS.
-reduced perfusion of part of lung (V/Q under 1)- PE.
T2 respiratory failure- low O AND high CO2
Mechanism-
Ventilation pump failure- hypoventilation.
Causes of T2 failure-
-primary muscle disorder- myopathy, MND
-chest walls problems-obesity, kyphoscoliosis, flail segment
-poor lung compliance- fibrosis.
-high airway resistance- severe acute asthma, late COPD.
Other causes hypoventilation-
-brainstem respiratory depression- head injury, opiates.
-SC trauma
-phrenic and ICN- guillain barre
-NMJ-MG
-pleural cavity- pneumothorax, large pleural effusion.
-upper airway obstruction- laryngeal oedema, FB.
Acute effects-
SOB
Acidosis
Usually requires assisted ventilation